The tables below explain the specific benefits and covered medical expenses provided by Scholastic Insurance Services in 2002-2003.

These benefits are applicable to students and scholars from all of SIS' client schools except USC International Students.

If you are a USC International Student (not a USC Scholar), click here to see your benefits table.

Covered Medical Expenses	In PPO	Outside PPO
1. Physician Office Visits	No Deductible. 100% of Reasonable Expenses after $20 Copayment per visit	75% of Reasonable Expenses
2. Inpatient Hospital Services	100% of Reasonable Expenses after $50 Copayment per Injury or Sickness	75% of Reasonable Expenses
3. Hospital and Physician Outpatient Services	100% of Reasonable Expenses after $50 Copayment per Injury or Sickness	75% of Reasonable Expenses
4. Therapeutic termination of pregnancy (In PPO and outside PPO combined shall not exceed $500 per Policy Year)	100% of Reasonable Expenses up to $500 Policy Year maximum	75% of Reasonable Expenses up to $400 Policy Year maximum
5. Elective termination of pregnancy (In PPO and outside PPO combined shall not exceed $500 per Policy Year)	100% of Reasonable Expenses up to $500 Policy Year maximum	75% of Reasonable Expenses up to $400 Policy Year maximum
6. Repairs to sound, natural teeth required due to an injury (In PPO and outside PPO combined shall not exceed $500 per Policy Year)	100% of Reasonable Expenses up to $500 Policy Year maximum/$100 per tooth	75% of Reasonable Expenses up to $500 Policy Year maximum/$100 per tooth
7. Treatment of Mental and Nervous Disorders
a. Inpatient treatment (In PPO and outside PPO combined shall not exceed 30 days per Policy Year)	100% of Reasonable Expenses for 30 days	75% of Reasonable Expenses for 30 days
b. Outpatient treatment (In PPO and outside PPO combined shall not exceed $1,000 per Policy Year)	100% of Reasonable Expenses up to $1,000 Policy Year maximum	75% of Reasonable Expenses up to $1,000 Policy Year maximum
8. Treatment of Drug and Alcohol Abuse
a. Inpatient treatment (In PPO and outside PPO combined shall not exceed $1,000 per Policy Year)	100% of Reasonable Expenses up to $1,000 Policy Year maximum	100% of Reasonable Expenses up to $1,000 Policy Year maximum
b. Outpatient treatment (In PPO and outside PPO combined shall not exceed $1,000 per Policy Year)	100% of Reasonable Expenses up to $1,000 Policy Year maximum	75% of Reasonable Expenses up to $1,000 Policy Year maximum
9. Outpatient Back and Spine Treatment (including Modalities) (In PPO and outside PPO combined shall not exceed $1,000 per Policy Year)	100% of Reasonable Expenses up to $1,000 Policy Year maximum/$50 per visit/maximum of three visits per week	75% of Reasonable Expenses up to $1,000 Policy Year maximum/$50 per visit/maximum of three visits per week
10. Outpatient Prescription Drugs (including oral contraceptives)	50% of actual charges Students of Foothill and De Anza Colleges: 100% of actual charges	50% of actual charges Students of Foothill and De Anza Colleges: 100% of actual charges
11. Annual cervical cytology (Pap Smear Screening)	100% of Reasonable Expenses	75% of Reasonable Expenses
12. Low-dose Mammography Screening	100% of Reasonable Expenses	75% of Reasonable Expenses
13. Medical Treatment Received in Home Country, if Not Covered by Other Plan	Not applicable	75% of Reasonable Expenses up to $1,000 lifetime maximum
14. Medical Treatment Arising from participation in Inter-collegiate or Inter-scholastic sports	100% of Reasonable Expenses up to $10,000 Policy Year maximum (see exclusions)	75% of Reasonable Expenses up to $10,000 Policy Year maximum (see exclusions)
15. Routine nursery care of a newborn child of a covered pregnancy (The coverage applies only during the first 31 days after birth. It consists of the following: hospital services, attending pediatrician services for the care of a healthy newborn while in the Hospital; and treatment of standard neo-natal jaundice)	100% of Reasonable Expenses up to $750 Policy Year maximum	75% of Reasonable Expenses up to $500 Policy Year maximum
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Benefits Table for USC International Students ONLY

The benefits table below is for USC International Students only. If you are a USC Scholar, or a student from any other school, click here to see your benefits table.

Covered Medical Expenses	In PPO	Outside PPO
1. Physician Office Visits	90% of first $50,000, then 100% up to maximum	60% of actual charges
2. Inpatient Hospital Services	90% of first $50,000, then 100% up to maximum	60% of actual charges
3. Hospital and Physician Outpatient Services	90% of first $50,000, then 100% up to maximum	60% of actual charges
4. Therapeutic termination of pregnancy (In PPO and outside PPO combined shall not exceed $500 per Policy Year)	90% of Reasonable Expenses up to $300 Policy Year maximum	60% of Reasonable Expenses up to $250 Policy Year maximum
5. Repairs to sound, natural teeth required due to an injury (In PPO and outside PPO combined shall not exceed $500 per Policy Year)	90% of Reasonable Expenses up to $250 Policy Year maximum/$100 per tooth	90% of Reasonable Expenses up to $250 Policy Year maximum/$100 per tooth
6. Treatment of Mental and Nervous Disorders and Substance/Alcohol Abuse
a. Inpatient treatment (In PPO and outside PPO combined shall not exceed 30 days lifetime maximum)	Lifetime maximum of 50% of Reasonable Expenses for 30 days	Lifetime maximum of 30% of Reasonable Expenses for 30 days
b. Outpatient treatment (In PPO and outside PPO combined shall not exceed $750 per Policy Year)	90% of Reasonable Expenses up to $750 Policy Year maximum	60% of Reasonable Expenses up to $600 Policy Year maximum
7. Outpatient Back and Spine Treatment (including Modalities) (In PPO and outside PPO combined shall not exceed $250 per Policy Year)	90% of Reasonable Expenses up to $250 Policy Year maximum/$50 per visit/maximum of three visits per week	60% of Reasonable Expenses up to $250 Policy Year maximum/$50 per visit/maximum of three visits per week
8. Outpatient Prescription Drugs (including oral contraceptives)	50% of actual charges	50% of actual charges
Other Coverages
9. Repatriation of Remains - Maximum Benefit $7,500
10. Medical Evacuation - Maximum Benefit $10,000
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Disclaimer
The policy specifics are subject to change without notice. Scholastic Insurance Services is not responsible for any mistakes or errors. Please read carefully through the benefits brochure that is sent out with your insurance coverage for the most accurate information.